Sinus Perforation Treatment & Classifications

Tooth loss in the posterior area of the maxilla will result in the atrophying of bone along the alveolar ridge over time. This can make implant placement in the sinus area impossible without first re-establishing sufficient bone height. The traditional answer to this problem is the lateral window sinus lift.

33. The Role of Guided Tissue Regenerative Therapy in Today’s Clinical Practice By Paul A. Fugazzotto

Guided tissue regeneration (GTR) was introduced into clinical practice in the United States in the mid-1980’s, and quickly became an important component of the clinical periodontists’ therapeutic armamentarium. GTR is conceptually based upon the selective repopulation of a previously diseased root surfaces by specific cell types. GTR utilizes an occlusive membrane, which is placed to create space for regeneration and to prevent ingrowth of cells from the overlying epithelium or the connective tissue corium. While the cells in the marrow spaces of the supporting osseous structures facing the defect and root surface could theoretically repopulate the diseased root surface, the relatively slow migratory capacity of these cells renders such a consideration moot. As a result of appropriate membrane selection and placement, the pluri potential mesenchymal cells in the perivascular tissues of the periodontal ligament migrate over the previously diseased root surface, effecting regeneration of damaged periodontal attachment apparatus. Such regeneration is characterized by the formation of new cementum and Sharpey fiber insertion into the cementum. When utilized appropriately, GTR therapy yields highly predictable therapeutic results, when treating both periodontally involved furcations and infrabony defects. The aim of this article is to provide a timely update on the role of GTR therapy in today’s clinical practice.

Generalized external root resorption (ERR), only the upper jaw, on permanent teeth is a rare finding. The treatment of multiple ERR depends on the symptoms, extent, and severity of the root resorption. Implant placement in patients with a history of multiple ERR has not been previously documented, and its predictability remains unknown.

Guided bone regeneration (GBR) using a nonabsorbable barrier has provided clinicians with the ability to place implants in sites that are compromised by insufficient bone including those where teeth have been immediately extracted. GBR efforts originally involved a barrier of expanded polytetrafluoroethylene (ePTFE) used alone or in conjunction with a bone replacement graft. Today, resorbable barriers have gained much favor with this treatment.

The restoration of anterior maxilla in an esthetically acceptable way is probably the most challenging of all clinical scenarios. Ideal implant positioning as well as proper soft tissue management is the key to achieve optimal esthetic result. Immediate loading of dental implants is now an accepted clinical reality and provides the clinician with an option to rehabilitate the anterior maxilla with immediate provisional restorations thus enhancing patients’ comfort. The following case report is of a patient who was treated with immediate provisional restorations and soft tissue contouring was carried out to achieve harmonious hard and soft tissue esthetics.

This review was made to establish the convenience of Dental Implant treatment in patients receiving bisphosphonates. Clinicians must be aware of the potential risk of Osteonecrosis in patients treated with bisphosphonates via the oral or intravenous route. Bisphosphonates related osteonecrosis of the jaw (BRONJ) is a well documented devastating side effect of long term bisphosphonates (BP) use. There is scarce information in the literature on BRONJ associated with dental implants (DIs). It would be of interest to design studies to evaluate the risk factors among dental implant patients receiving treatment with bisphosphonates.